Individual
MARISA P LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1330 SE 4TH AVE STE J, FORT LAUDERDALE, FL 33316
(954) 620-3307
Mailing address
9960 NW 116TH WAY STE 13, MEDLEY, FL 33178-1175
(786) 924-1311
(786) 924-1313
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
2084N0400X
Neurology Physician
Primary
ME90785
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269970200
—
FL
Enumeration date
05/22/2006
Last updated
12/18/2019
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